03060050Y�t
OF
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a
CITY OF CUPERTNO
CONTRACTOR INFORMATION
BUILDING DIVISIONNPERMIT
PERMIT
a _;tet �a5 iy>ft,ak , ,>
'
BUILDING ADDRESS:
MORTON FINHILL
PERMIT N0,
03060050
O NER NAGl�
PERMIT ISSUE DAM
06/06/2003
NE:
SANITARY NO, CONTROL NO,
RCHITER/ENGINEFR:
BUILDING PERMIT INFO
BLDG MECH
ELECT PLUMB
I� 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 Mreby option that I am li¢vM under ptrvisi ses Of Chapter 9 (commencing
with Section 7”) of Division 3 O the Business end Professions Code, end my license is
Or Liec.Claass, rom d efrccs tie.0
REVISION --IN
HOUSE USE ONLY
Date -ARCHITECTS DECLARATION
NO NEW PERMIT ISSUED, ORIG. #03010060
I undemund my plans shall W used as Public records
/J
Licensed Proportional
OWNER -BUILDER DECLARATION
1 hereby a1Bw Nal 1 License Iron for the
exempt from W Cerins
Q e—
o
i following meson. (Section IDs t. 5. Business and Cale: Any city of county
w. dcrions
which requires a pewit to construct, alwr, impwe, demnlixh, or rePan 'any arrucmm
s
F
m ole a License, Lewd smwmcm
Of for Contractor
icusn purse nt to the lW Provisions
? prior m i focused
that
Sq. Ft. Floor Area
Valuation
me ccensedpuution7 )provisionsoftheComsiness nPrOflrw(Chapmr9
(commencingwithSedirn]land) of Division J of Me Business Pro Code) of
Any vi
Man W H exempt there(mm and the breis for the glegrd exemption. Any violation of
pt
APN Number
Occupancy Type
Section 7031.5 by any applicant fon permit subjects the applicant o a civil penally of
not more Nan fate hundred dollen (5500).
❑I,mowmr of the proputy,amy emplaycu with wages nsBeir vele compenmuon,
36230023.00
will do Ne work and Ne attract. is not intended or offered forage (See. 7044, Business
Required Inspections
and Prefeuions Code: TW Commerce. Lim. Law does not apply to an.1 of
property, who Wiadsarimproves thnmv,.nd who doessuch workhmeclforthrough his
101
- FOUNDATION
own employees. provided that such improvements are not mended oroffend formic. If.
102
PIERS
however. the building or improvement is sold within one year of completion. Ne owner-
—
bullder will have Mc burden or proving that he did not Wild or improve for purpose of
103
— UFER
coe.).
104
- REBAR
1, as owner of Mc property. am exclusively contracting with licensed contractors to
consumer the project Sm. 70sa. Business and Professions Codc:) The Contractor's Li-
105
— ANCHOR BOLTS
cense Law does not apply to an owner of properly who Wilds or Improves Blemon. and
who contacts for such projects with a conVrttor(s) licensed pursuant to the Contractor's
106
— SEWER & WATER
License
❑ 1 am Laempl under Sec. . B & P C for Nia moron
.emr
202
- UNDERFLOOR PLUMBING
203
- UNDERFLOOR MECHANICAL
ower ow
204
- UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
I hcmbyaM. under penalty of pe do, one of the following dcciarmonc:
205
— UNDERFLOOR INSULATION
Inaeand will common.CerarcateofConsent tosalf-insure for WorkarsConifer-
301
- ROUGH PLUMBING
lion, u provided for by Section 3700 of the arbor Code. for the perfomance of the
302
- TUB & OR SHOWER
work for which this permit is issued.
1 have and will maintain Wurkor's Compensation Insunnm, ns required by Section
3 03
- ROUGH MECHANICAL
3700 of W labor Codc, for the performance of the work for which this monit is issued.
304
— ROUGH ELECTRICAL
My Worker's Compensation Insurance canner and Policy number are:
305
— FRAME
Cartier. Polity No.:
306
— HOLDOWNS
_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
307
- INSULATION
(this section recd not be completed it the permit is for one hundred doll. ISIM)
308
- SHEETROCK
or Icor.)
I certify Net in Ne mrroonence of the work for which this permit is issued, l shall or
3 09
- EXTERIOR LATH
employ any person in any manner an at to become subjoel to W Workcri COrrKnmrion
310
— INTERIOR LATH
Irwac.hraroi.. Dam
Applicant
311
313
- SCRATCH COAT
- ROOF NAIL
NOTICE TO APPLICANT: If, after making this Ccnihceof ofioyoushould
'm
become object to the WorkuwW Labor
Compction provisions of tabor CMc, you most
fnnhwith comply who such prnrimm.orMia prmhshall Wdeemed revoked.
501
- FINAL ELECTRICAL ENERGY
1 CONSTRUCTION LENDING AGENCY
502
- FINAL PLUMBING ENERGY
Ihockey amw Mom them iu construction fat Mm perfowarex of
' the work for which Ihis permit is issued (Sec. ], Civ. C.)
503
— FINAL MECHANICAL ENERGY
Lenin's Name
504
- FINAL BUILDING ENERGY
1<nda,.Add.
505
- FINAL ELECTRICAL
1 certify that l have read this application and some that the above information is
correct I agree to comply with gl city and county, ordinances and state laws minting to
506
- GAS TEST
Wilding construction, and hereby.ubmim representatives of this city to enter upon one,
5
—6FINA PLUMBI
above-mentioned property for inspection purposes.
agree to mK, Indemnify and keep hourcleis die City Of C.pcnlno agamst
5 $
T(We)
yJ
( Iabllltin.j.dgmeml,cmus and cap. which may In any way aeCrne aSaima said City
in...Icgmnm of Inc flaming of this pewit
5 0
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by,
- NG Da
SOURCE REGULATIONS.
Re -roofs
Type of Roof
- L PUBLIC WORKS
SignatureofApplicm Dao
HAZARDOUS
US MATFRIALS DISCLOSURE
Will she or future building Occupant pore or handle ety
sd
ns OcOned e CuKrt
the Cupertino Municipal Calc. Chapter 9.11, and the Hcalth and Sgety
HealthSafety
Cade, OYka 155311x)7
Section
❑Yu ❑No
All roofs shall be inspected prior to any roofing material being installed.
win the . Went err future building oma
Pp g W ^I use equipment or devices which
If a roof is installed
without first obtainingan inspection, I agree to remove
P g
mh herardn.s air cantaminsna m deBnod by the Bay Am. Air Quality Management
all new materials
for inspection.
isuinT
Oyes ON.
I have mrd Ne Wea dousmalcrials requirements uncer Chapmrii.95of W Celifor-
ria Health A SdeiyCocc, Sections 15305, 25533 and MM.1 understand Whir Ns Wilding
does .1 coronary hale a..4 dW 11 Is my reSpJnslbillly to notify One ..W, Of she
requimmcna which mum be met poor on issuance of a Ccniflee¢af Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or uthorimd agent Dow